Review for 1166 midterm exam revised Oct 2010. By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP. Question. You are reading the chart and you need to find the patient’s current Vital Signs prior to giving inhaled Beta II bronchodilator. Where would you look?. answer.
Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP
Your patient has a Pa02 of 45 mmHg on an entrainment mask at 35%.
To correct his hypoxemia [get the Pa02 to 80 mmHg] what Fi02 should you select?
Pa02actual : Fi02actual as Pa02you want: Fi02you need
45 mmHg : .35 as 80 mmHg: x
45 X = .35 (80)
45 X = 28
= 62% Fi02 we need
This patient needs a partial Non-rebreather mask to get the Pa02 back to normal
Your patient has the following:
HR is 88 BPM
RR is 18 BPM
Sp02 is 95%
Patient is alert and resting quietly
There are no retractions, no labored breathing
What could you say about this patient?
Pt has normal VS and normal Sp02
There are no s/s of respiratory distress nor of increased WOB
Your patient has been placed on 60% entrainment device on his face tent. If the set flow rate is 8 LPM, what is the total flow rate?
At 60% and 8 LPM
Based on the magic box, there is 1 LPM of air entrained for each 1 LPM of 02
8 LPM + (8 x 1) = 16 LPM
In the situation above in which the patient has a total flow of 16 LPM, could we call the entrainment device a high flow system?
Not really, the flow rate needs to be 2-3 x the VE to be a true high flow system.
We could increase the 02 flow to 15 which would result in a total flow of 30 LPM which is better
If you hear bronchial breath sounds over the larger airways this would be:
This is normal over the larger airway.
If this same sound was heard over the periphery of the lung we would be concerned about atelectasis or pneumonia in which the lung has become more dense
If your patient has rhonchial fremitus on palpation, and you hear coarse inspiratory & expiratory crackles that clear after a cough, your patient has what problem ?
Coarse crackles and rhonchial fremitus are both associated with fluid in the airways which would change with coughing effectively.
This could be associated with bronchitis
Your order states that you must keep your patient Sp02 above 92%.
Your patient has been gradually increased from 1 LPM nasal cannula to 5 LPM nasal cannula over a couple hours, the Sp02 is finally above 92%, and the RR has returned to normal with a normal HR.
What else can you do for your patient to make him more comfortable?
Add an cool bubble humidifier to the nasal cannula
Continue to monitor the VS and Sp02
Your patient is wearing a Non-rebreather mask in the recovery room. He is breathing slowly and shallowly.
For what one particular hazard of 02 might we be worried about in this case?
absorption atelectasis is a particular hazard of patients who are in post op.
Post op patients are already at high risk of post-op atelectasis
As the 02 molecules replace the N2 molecules they are quickly diffuse into the capillaries and the lung collapses
Your patient has been on 70% 02 for several days. What single particular hazard of 02 is he at risk for?
He is at increased risk of 02 toxicity in which increased 02 radicals will damage the lung tissue
Your patient has chronic hypercapnia associated with morbid obesity. His normal Pa02 ranges between 55- 65 mmHg.
If he is placed on a higher level of Fi02 than he needs, what particular hazard of 02 would he be at risk for?
02 triggering a lost of his hypoxic drive
The Pa02 rises to ‘normal’ his brain stops asking for breaths
Because the PaC02 started off abnormally high, and because his body has adjusted to that his PaC02 starts to rise to the point that it becomes a sedative [PaC02 above 70 mmHg]
When performing percussion for diaphragmatic excursion , we would percuss until the resonance becomes dull.
If you are percussingbelow the rib cage, you are percussing abdominal structures; this is the end of the diaphragm. The diaphargm can be found between the 9th and the 12th ribs depending on how deep the breath is.
If you are still above the diaphragm, this change to dullness would imply that there is consolidation, atelectasis or pleural effusion present over the area